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Plan A Forms

The following forms are available under Health and Welfare Plan A.

 

  • CarelonRx Mail Order Form
  • CarelonRx Reimbursement Form
  • Annual Physical and Hearing Aid Claim Form
  • Appointment of Personal Representative
  • Blue Cross Health Insurance Claim Form
  • Dental Claim Form
  • Designation of Beneficiary
  • MetLife - Disability Claim Form - Plan A Only
  • Davis Vision Out of Network Claim Form
  • MetLife - Participant Life Insurance Form
  • Travel and Lodging Claim Form

 

 

The Funds

  • Plan A
  • Summary Plan Description
  • Summary of Benefits and Coverage
  • Plan A Features
  • Plan A Rates
  • Plan A Forms
  • Plan C
  • Summary Plan Description
  • Summary of Benefits and Coverage
  • Benefits at a Glance
  • CAPP Quarterly Rates
  • MRP Guidebook
  • Plan C Forms
  • Retiree-MRP
  • Summary Plan Description
  • RMRP Guidebook
  • COBRA
  • Cobra Rates
  • COBRA - Disability Rates
  • Forms/Documents
  • Trustees
  • Annuity Fund
  • Summary Plan Description
  • Summary Plan Description - Spanish
  • Link to Principal
  • Deferred Salary Agreement Form
  • Managing your IATSE Annuity Fund Account
  • Important Participant Notice Regarding Qualified Default Investment Alternative
  • Forms/Documents
  • Trustees
  • Plan B
  • Summary Plan Description
  • Plan C
  • Summary Plan Description
  • Forms/Documents
  • Trustees

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